Organization
AZ INTERACT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARDO SANTANA (ADMINISTRATOR)
(602) 636-0488
Entity
Organization
Contact information
Practice address
2325 W DESPERADO WAY, PHOENIX, AZ 85085-5777
(602) 696-0488
Mailing address
2325 W DESPERADO WAY, PHOENIX, AZ 85085-5777
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4514
AZ
Other
Enumeration date
09/26/2014
Last updated
09/26/2014
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